September 1st marks the arrival of a vaccine for people aged 70 years (routine cohort) and 79 years (catch-up cohort) to protect against shingles The efficacy of the vaccine declines with age and so it is not recommended for people aged 80 years or older.
The brand name of the shingles vaccine given in the UK is Zostavax
Unlike the flu jab, you’ll only need to have the vaccination once.
The vaccine is expected to reduce your risk of getting shingles. If you are unlucky enough to go on to have the disease, your symptoms may be milder and the illness shorter.
It’s difficult to be precise, but research to date suggests the shingles vaccine will protect you for at least three years, probably longer.
There is lots of evidence showing that the new shingles vaccine is very safe. It’s already been used in several countries, including the US and Canada, and no safety concerns have been raised. The vaccine also has few side effects.
What is Shingles?
Shingles or Herpes Zoster is a debilitating condition, which occurs more frequently and tends to be more severe in older people. It is estimated that around 250,000 people are affected in England and Wales each year, including 30,000 people in their 70s. Around one in 1,000 people over 70 who get shingles dies of the infection.
About 1 in 5 people have shingles at some time in their life. It can occur at any age, but it is most common in people over the age of 50. It is uncommon to have shingles more than once, but about 1 person in 50 has shingles two or more times in their life.
Most people have chickenpox ( varicella Zoster)in childhood, but after the illness has gone, the virus remains dormant (inactive) in the nervous system. The immune system (the body’s natural defence system) keeps the virus in check, but later in life it can be reactivated and cause shingles.
It is not known exactly why the shingles virus is reactivated at a later stage in life, but it may be due to having lowered immunity (protection against infections and diseases). This may be the result of:
a condition that affects your immune system, such as HIV and AIDS
Debilitation associated with cancer or medication affecting the immune system.
Each spinal nerve supplies an area of skin called a dermatome. The virus lies dormant in a part of the spinal nerve called a ganglia and as each spinal nerve supplies a particular region of the skin the area of skin where the symptoms and rash appear will correspond to that dermatome.
Signs & Symptoms,
Prodrome (1–4 days before the rash) — fever and myalgia, with burning, tingling, numbness, or intense itching in the affected skin.
Acute (painful rash lasting 7–10 days) — a rash starts with red flat lesions and then raised lesions and these develop into vesicular (blistery)lesions in a dermatomal distribution. These blister type lesions then burst, releasing varicella-zoster virus.
Healing (2–4 weeks) — the lesions crust over.
Most patients feel unwell and very often emotionally labile and many a time has a patient with shingles burst into tears during a consultation for no obvious reason.
An oral antiviral drug (such as aciclovir) should be started within 72 hours of rash onset for a certain group of people, such as people aged 50 years or older, people with non-truncal involvement (e.g. shingles affecting the neck, limbs, or perineum), and people with moderate or severe pain or rash.
If it is not possible to initiate treatment within 72 hours, antiviral treatment can be considered up to 1 week after rash onset, especially if the person is at higher risk of severe shingles or complications (e.g. continued vesicle formation, older age, immunocompromised, or severe pain).
Most people have shingles on the trunk or chest region and it is uncomplicated. However, some people are unfortunate in that they are infected in the facial area, develop a complication, are severely immunocompromised, or pregnant and may need urgent admission or a Specialist opinion.
Less urgent referral may be necessary if new vesicles are forming after 7 days of antiviral treatment, healing is delayed, or if pain is inadequately controlled by oral analgesia.